Employment Application

Equal Opportunity Employer and Drug-Free Workplace

We receive applications and hire employees without regard to race, creed, color, sex, religion, age, national origin, marital status, physical or mental handicap, disability, veteran’s status and citizenship status, or any other protected category. The receipt of this application does not mean that job openings exist and does not obligate us in any way. We appreciate your interest in our organization.

Personal Information

Name

Present Address

City

State

ZIP

Telephone Number

How long there?

Previous Address

Are you Bilingual? Yes No

Are you over the age of 18? Yes No

If no, employment is subject to verification of minimum legal age.

Are you legally eligible to work in the U.S.? Yes No

Employment Information

Type of position applying for? (Check all that apply)
Executive
Administrative
Clerical
School Age
Middle School
Preschool
Special Needs
Advertised Position Title

Date available for work:

Type of employment (Check all that apply): Full Time Part Time

Temporary: Summer Spring Break Christmas Break

What days and hours are you available to work?
Days: Hours:

Have you ever applied for a job or worked with us before? Yes No

If yes, when?

Have you ever been bonded? Yes No

Have you ever been refused a bond? Yes No

If so, state reason and date:

Have you ever been convicted of any crime other than a minor traffic violation? Yes No

If so, explain:

Does your present employer know of your plans to change employment? Yes NoWhy do you desire to make a change?

Have you ever held a position of trust (handling money or confidential material)? Yes No

Do you have steady transportation to work? Yes No

Have you ever been discharged or asked to resign? Yes No

List any other experiences, skills or qualifications you have that specifically relate to working here?

Can you perform the duties of the job for which you are applying, with or without reasonable accommodation?
Yes No

Education Information

Describe any other specialized or professional training (such as business, technical or nursing school). Include study courses given through public or private employment. State whether degree or certificate received.

Past Employment Information

(Start with your most recent or current employer. Please answer N/A if you have no prior work experience.)

Name, Address & Phone No. of Most Recent Employer

Immediate Supervisor (Name & Position)

Date Hired:

Date Left:

Starting Pay:

Last Pay:

Your Job Title & Duties

Reason for leaving

Name, Address & Phone No. of Most Recent Employer

Immediate Supervisor (Name & Position)

Date Hired:

Date Left:

Starting Pay:

Last Pay:

Your Job Title & Duties

Reason for leaving

Name, Address & Phone No. of Most Recent Employer

Immediate Supervisor (Name & Position)

Date Hired:

Date Left:

Starting Pay:

Last Pay:

Your Job Title & Duties

Reason for leaving

May we contact the employers listed above? Yes No

If not, indicate by number which one(s) you do not wish us to contact:

References

(Do not list relatives or former employers)

Name

Occupation

Phone

Name

Occupation

Phone

Name

Occupation

Phone

Authorization

The facts set forth above in my application for employment are true and complete. I understand that if employed, false statements or omission of information on this application, a resume, or other applicant information provided may be considered sufficient reason for dismissal. You are hereby authorized to make any investigation of my personal history and financial and credit record through any investigative or credit bureaus of your choice. In making this application for employment I also understand that an investigative consumer report may be made whereby information is obtained through personal interviews with my neighbors, friends, or others with whom I am acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living. I understand that I have the right to make a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigative consumer report.

I authorize the use of any information in this application to verify my statements, and I authorize the past employers, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record. I release all such persons from any liability or damages on account of having furnished such information. I understand that employment at this organization is on an “at will” basis, and includes no guarantee, contract or promise of employment for any specific length of time. I also understand that I must submit to a pre- employment drug test.